------ TWO LEFT FEET DANCE ------ Beginner Friendly Dance Lessons

Laugh with Us, Dance with Us!

Registration-Kids & Teen

TWO LEFT FEET DANCE.com
Two Left Feet Dance Studio
217 Market Street West
Gaithersburg, MD 20878
In the Kentlands Market Square
301-346-2499 or 240-632-2345
KIDS & TEEN REGISTRATION FORM
Click & Highlight the section you want to copy & print.

To Register: Print a copy of this form. Fill out the information requested. Keep a copy for your records. We will e-mail a confirmation as a receipt of your registration.

Please make your checks payable to TWO LEFT FEET DANCE.

Send your check to 217 Market Street West, Gaithersburg, MD 20878.
We also accept cash as a form of payment. We do not take credit cards.

Name of Student: ______________________________________
Grade: _______ Age: _______
Address: _______________________________________________
City: _________________ State: ________ Zip: _______
Home Phone: (_____)____________

PARENT #1: Name:__________________________

Cell Phone: (_____)____________
E-mail: __________________________

PARENT #2: Name:__________________________
Cell Phone: (_____)___________
E-mail: __________________________

How did you learn about Two Left Feet? _________________________________________________________

GROUP CLASS DAY

Circle: - MON - TUES - WED - THURS - FRI - SAT -

TIME:_______ START DATE:___/___/_____

CLASS TYPE:Circle: - Mini Kids - Kids - Teen - Teen Ballroom -

FEE: Mini- Kids $80/child for 8 classes _____

10 Group Classes $265/child or teen _____

10 Teen Group Ballroom plus Teen Dance Social $200/teen _____

PRIVATE KIDS PARTY:

Date: ______/______/______ Time: ________
1 hour = $135

(Please include and mail in any discount certificates you may have with this registration.)